Overweight And Obesity Guidelines

DOCTOR'S VIEW ARCHIVE

In June of 1998, the National Heart, Lung, & Blood
Institute of the National Institutes of Health (NIH)
updated the guidelines for the definition and treatment of
obesity.

The NIH guidelines no longer utilize the traditional
height/weight charts for defining obesity that insurance
companies have relied on for years. According to these new
guidelines, assessment of overweight involves evaluation of
three key measures-body mass index (BMI), waist
circumference, and a patient's risk factors for diseases
and conditions associated with obesity.

Below are listed some of the new guidelines. These
guidelines present a new approach to the assessment of
overweight and obesity and establish principles of safe and
effective weight loss.

The body mass index (BMI) equals a person's weight in
kilograms (kg) divided by their height in meters (m)
squared. Since BMI describes body weight relative to
height, it is strongly correlated with total body fat
content in adults.

To estimate BMI using pounds and inches, use the weight
in pounds (lb) divided by the height in inches (in) squared
and multiply the result by 704.5.

"Overweight" is defined as a body mass index (BMI)
value of 27.3 percent or more for women and 27.8 percent or
more for men. These definitions of overweight are based on
an analysis of BMI relative to the risks of disease and
death.

"Obesity" is defined as a BMI of 30 and above. A BMI of
30 is about 30 pounds overweight. (Notably, some very
muscular people may have a high BMI without health
risks).

According to the NIH guidelines, the most successful
strategies for weight loss include calorie reduction,
increased physical activity, and behavior therapy designed
to improve eating and exercise habits. Recommendations
include:

Engaging in moderate physical activity, progressing
to 30 minutes or more on most or preferably all days of the
week.

Cutting back on dietary fat can help reduce calories
and is heart-healthy. But reducing dietary fat alone-
without reducing calories-will not produce weight loss.

The initial goal of treatment should be to reduce
body weight by about 10 percent from baseline (starting
weight), an amount that reduces obesity-related risk
factors.

A reasonable time line for a 10 percent reduction in
body weight is 6 months of treatment, with a weight loss of
1 to 2 pounds per week.

Weight maintenance should be a priority after the
first 6 months of weight-loss therapy.

In carefully selected patients (BMI >30 without
additional risk factors or BMI >27 with two or more risk
factors) who have been unable to lose weight or maintain
weight loss with conventional nondrug therapies, weight-
loss drugs approved by the FDA for long-term use may be
tried as part of a comprehensive weight loss program that
includes dietary therapy and physical activity.

During the weight maintenance phase of treatment,
drug therapy may also be used. However, drug safety and
effectiveness beyond one year of total treatment have not
been established.

Weight-loss surgery is an option for carefully
selected patients with clinically very severe obesity-BMI
of > 40 or BMI of >35 with coexisting conditions when less
invasive methods have failed and the patient is at high
risk for obesity-associated illness. Lifelong medical
surveillance after surgery is a necessity.

Overweight and obese patients who do not wish to lose
weight, or are otherwise not candidates for weight loss
treatment, should be counseled on strategies to avoid
further weight gain.

Age alone should not preclude weight loss treatment
in older adults.

This information should be used as a compliment to
MedicineNet's article on the topic which can be found in
the Obesity Center.

You can calculate your own BMI by reading the MedicineNet.com article, Calculate Your BMI.